A recent study came out that revealed an estimated 7% of American adults have experienced long COVID. That is 17.8 million individuals - a striking number of people who have dealt with a condition that medicine has a difficult time helping people with because of its complexities and also, advancements and innovation in medicine moves slowly.
Individuals with long COVID are more likely to have mental health changes related to inflammation and immune changes. The most common psychiatric manifestation resulted to be sleep disturbances, followed by depression, PTSD, anxiety, and cognitive impairment (i.e., attention and memory deficits). Because of functional medicine's focus and expertise on inflammation and immune system regulation for a myriad of similar conditions like fibromyalgia, chronic fatigue syndrome, and chronic lyme disease, functional medicine is uniquely equipped to help individuals with long COVID.
Low Dose Naltrexone for Long COVID
One emerging therapy garnering interest for long COVID is low dose naltrexone (LDN). Naltrexone has been used in much higher doses to treat opioid and alcohol addiction by blocking opioid receptors in the brain. However, at very low doses of around 1-4.5 mg taken typically at bedtime, it can paradoxically produce an opposite effect.
The proposed mechanism behind LDN's benefits for long COVID and other chronic inflammatory conditions is its temporary upregulation of endorphin production.
Endorphins, the body's natural opioids, bind to opioid receptors on immunoregulatory cells like lymphocytes and macrophages. This helps regulate the immune system by reducing pro-inflammatory cytokine production.
Additionally, the increased endorphin levels from LDN are thought to help reduce neuroinflammation and associated symptoms like pain, fatigue, and cognitive impairments often seen in long COVID. Endorphins can modulate microglial activation and promote anti-inflammatory and neuroprotective effects in the central nervous system.
Some studies on LDN for other chronic inflammatory and autoimmune conditions like fibromyalgia, Crohn's disease, and complex regional pain syndrome have shown promising results in reducing symptom severity and improving quality of life. While data is still limited for long COVID specifically, anecdotal reports suggest LDN may help certain patients better manage their most disruptive symptoms.
Potential benefits reported by long COVID patients taking LDN include:
Reduced body pain and headaches
Improved mood, sleep quality and cognition
Decreased fatigue and post-exertional malaise
Relief from neurological symptoms like brain fog and dysautonomia (POTS)
As with any treatment, LDN does carry some risk of side effects, which are usually mild and transient. These can include sleep disturbances, vivid dreams, and gastrointestinal upset. It's crucial for patients to work closely with healthcare professionals experienced in LDN use to determine appropriate dosing and monitor response.
Photobiomodulation for Long COVID
Photobiomodulation (PBM) involves the use of near-infrared LEDs that emit wavelengths of light that interacts with cells and potentially promotes healing and improved function. While the exact mechanisms are still being investigated, PBM therapy involves applying specific wavelengths of light to targeted areas of the body. Research suggests PBM may influence cellular processes like inflammation, energy production, and tissue repair. This has led to its exploration for various conditions, including Long COVID symptoms, fatigue, and even some mental health concerns. Small studies are showing promise, with a low side effect profile.
Photobiomodulation can be applied in different ways - whole body or targeted body parts such as a helmet. The use of PBM therapy has shown significant therapeutic efficacy in brain conditions such as Parkinson's disease, Alzheimer's disease, dementia, mild cognitive impairment, traumatic brain injury, post-traumatic stress disorder, Gulf War illness, and depression, among many others. In regards to the best type of application for long COVID, it remains unknown but small studies have shown equal benefit in use of a helmet or whole body device such as a bed or a mat, when utilized 3 times a week, for four weeks for a duration of 14 minutes. Overall, this modality is well-tolerated and easy to use. It has shown benefit for helping specifically with long COVID-related fatigue, brain fog, and cognitive challenges.
Treat the Gut for Long COVID
Long COVID patients often exhibit a disrupted gut microbiome, a condition called gut dysbiosis.
This dysbiosis is characterized by:
Increased F/B ratio: This imbalance can trigger inflammation and contribute to autoimmune issues, potentially explaining some Long COVID symptoms.
Reduced butyrate-producing bacteria: Butyrate is a beneficial fatty acid that nourishes gut lining cells and supports a healthy immune response. Its depletion in Long COVID patients might contribute to further complications.
Low biodiversity: A diverse gut microbiome is essential for optimal health. Reduced diversity weakens the gut's ability to function properly.
Several theories attempt to explain why gut dysbiosis might occur in Long COVID:
Overactive Immune System: COVID-19 infection can trigger an aggressive immune response, potentially harming beneficial gut bacteria in the process.
Leaky Gut Syndrome: This condition, often associated with gut dysbiosis, allows harmful inflammatory substances to leak from the gut into the bloodstream, further activating the immune system and creating a vicious cycle.
Viral and Fungal Disruptions: Viruses like Epstein-Barr virus (EBV) and fungi like Candida can emerge with lond COVID and disrupt gut bacteria composition, increasing the risk of autoimmune responses.
Interestingly, women seem to be more susceptible to Long COVID. Hormonal influences, particularly estrogen, may play a role. Estrogen can promote Candida overgrowth, leading to gut dysbiosis and potentially explaining the higher prevalence of Long COVID in females.
In functional medicine, we utilize framework to address gut dysbiosis, a potential contributor to Long COVID symptoms called the 5R Approach:
Remove: This stage focuses on eliminating factors that disrupt gut balance. This could involve:
Dietary Changes: Identifying and removing foods that trigger sensitivities, intolerances, or allergies in the individual.
Pathogen Reduction: Addressing pathogenic microflora (harmful bacteria, fungi, or parasites) through botanical antimicrobials, antibiotics, or antifungals under medical supervision.
Stress Management: Reducing environmental stressors like pollutants and emotional stress, potentially using techniques like elimination diets or stress management tools.
Detoxification: Removing toxins and stressors from the body through various approaches.
Replace: Here, we focus on replenishing essential digestive factors that may be depleted:
Digestive Enzymes: Replacing hydrochloric acid (HCl), pancreatic enzymes, and bile acids to support optimal digestion and nutrient absorption.
Fiber Support: Incorporating fiber-rich foods like fruits, vegetables, and whole grains to promote healthy gut transit and overall digestive function.
Reinoculate: This stage aims to repopulate the gut with beneficial bacteria:
Probiotics: While probiotics may not permanently colonize the gut, they can provide temporary support by introducing beneficial bacterial strains like Bifidobacteria, Lactobacillus, and Saccharomyces boulardii.
Prebiotics: Prebiotics act as "fertilizers" for existing gut bacteria, promoting their growth and activity. Examples include inulin, fructooligosaccharides, and various soluble fibers.
Synbiotics: These combine probiotics with prebiotics, offering a two-pronged approach of introducing beneficial bacteria and supporting their growth.
Repair: We focus on supplying nutrients essential for gut healing and immune function:
Gut Lining Support: Providing nutrients like glutamine, arginine, vitamin D, C, zinc, panthothenic acid, vitamin E, carotenoids, and phosphatidylcholine to repair the gut lining.
Immune Support: Lactoferrin, lactoperoxidase, whey immunoglobulins (I, and specific antioxidants like catechins can bolster the gut-associated lymphoid tissue (GALT) function, enhancing immune defense.
Anti-inflammatory Support: Nutritional and phytonutritional anti-inflammatories like curcumin, EPA, and DHA can help reduce gut inflammation.
Rebalance: This stage focuses on promoting overall well-being and supporting the body's natural healing processes. It importantly should not be done as a final stage but one to start right away:
Stress Management Techniques: Techniques like scheduling relaxation time, mindful eating, heart rate variability training, biofeedback, therapy, yoga, meditation, prayer, breathing exercises, or other centering practices can all contribute to stress reduction.
Vagal and Limbic System Retraining: We also have found programs that focus on balancing the limbic system and vagus nerve to be particularly helpful, such as the Gupta Program and Annie Hopper's Dynamic Neural Retraining System (DNRS).
Interested in an integrative approach to getting your life back from Long COVID? Learn more about becoming a patient at Driftless Integrative Psychiatry here.
A kind reminder: This blog post is designed as a general guide. This is not a substitute for personalized medical advice, nor is a patient-physician relationship established in this blog post.
References:
Bowen R, Arany PR. Use of either transcranial or whole-body photobiomodulation treatments improves COVID-19 brain fog. J Biophotonics. 2023 Aug;16(8):e202200391. doi: 10.1002/jbio.202200391. Epub 2023 Apr 29. PMID: 37018063.
Fang Z, Ahrnsbrak R, Rekito A. Evidence Mounts That About 7% of US Adults Have Had Long COVID. JAMA. Published online June 07, 2024. doi:10.1001/jama.2024.11370
Marchi, et al. (2023). Psychiatric symptoms in Long-COVID patients: a systematic review.(https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2023.1138389/full
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